Prediction of Insufficient Beta-Lactam Concentrations in Extracorporeal Membranous Oxygenation Patients

The aim of this study was to identify predictors of insufficient beta-lactam concentrations in patients undergoing extracorporeal membrane oxygenation (ECMO). Retrospective analysis of all patients receiving ECMO support and treated with ceftazidime or cefepime (CEF), piperacillin/tazobactam (TZP),...

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Bibliographic Details
Published in:Microorganisms (Basel) 2021-10, Vol.9 (11), p.2219
Main Authors: Polain, Amandine, Gorham, Julie, Romeo, Immacolata, Belliato, Mirko, Peluso, Lorenzo, Partipilo, Francesco, Njimi, Hassane, Brasseur, Alexandre, Jacobs, Frederique, Creteur, Jacques, Hites, Maya, Taccone, Fabio Silvio
Format: Article
Language:English
Subjects:
Amides
Antibiotics
Blood
Cefepime
Ceftazidime
Creatinine
critical illness
Drug dosages
ECMO
Extracorporeal membrane oxygenation
Infections
Intensive care
Length of stay
Meropenem
Mortality
Oxygenation
Patients
Piperacillin
Pseudomonas aeruginosa
Tazobactam
Tetragonal zirconia polycrystals
therapeutic drug monitoring
Therapy
Urine
Variables
β-Lactam antibiotics
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Summary:The aim of this study was to identify predictors of insufficient beta-lactam concentrations in patients undergoing extracorporeal membrane oxygenation (ECMO). Retrospective analysis of all patients receiving ECMO support and treated with ceftazidime or cefepime (CEF), piperacillin/tazobactam (TZP), or meropenem (MEM). Trough drug concentrations (C ) were measured before the subsequent dose, according to the decision of the attending physician. Insufficient drug concentrations were identified if C was below the clinical breakpoint of Pseudomonas aeruginosa. A total of 222 C (CEF, n = 41; TZP, n = 85; MEM, n = 96) from 110 patients were included; insufficient concentrations were observed in 26 (12%) antibiotic assessments; 21 (81%) of those occurred during MEM therapy. Insufficient C were associated with a shorter time from initiation of antibiotics to measurement, a lower single dose of antibiotic, a higher creatinine clearance (CrCL), lower sequential organ failure assessment (SOFA) scores, and less use of continuous renal replacement therapy (CRRT) when compared to others. Insufficient broad-spectrum beta-lactam concentrations were observed in 12% of drug measurement during ECMO therapy. Higher than recommended drug regimens could be considered in the very early phase of therapy and in those patients with augmented renal clearance and with less severe organ dysfunction.
ISSN:2076-2607
2076-2607
DOI:10.3390/microorganisms9112219